FINA Committee Meeting

STANDING COMMITTEE ON FINANCE

COMITÉ PERMANENT DES FINANCES

EVIDENCE

[Recorded by Electronic Apparatus]

Monday, November 29, 1999

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[English]

The Acting Chair (Mrs. Karen Redman (Kitchener Centre, Lib.): Pursuant to Standing Order 83.1, the committee resumes its pre-budget consultations.

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We will hear from the Canadian Cancer Society, the Heart and Stroke Foundation of Canada, the Council for Health Research in Canada, the Coalition for Biomedical and Health Research, Sidelines Canada, the Multiple Sclerosis Society of Canada, as well as the National Voluntary Organizations. Welcome.

Each of you, I assume, has been apprised that you have five minutes to make your presentation, after which we will have a round of questions from the committee members present.

I invite Mr. Kenneth Kyle, director of public issues from the Canadian Cancer Society to start us off.

[Translation]

My apologies, Mr. Loubier.

Mr. Yvan Loubier (Saint-Hyacinthe—Bagot, BQ): Madam Chair, as agreed last week with the members of the Finance Committee, I would like to table a report on the unfairness of the contribution of Canada's large corporations to federal taxes. It is a study done by the Ontario Federation of Labour entitled Unfair Shares: Corporations Taxation in Canada. I had promised the committee members that I would table this report and I sent a true copy of it to Mr. Thomas d'Aquino who said that he had no knowledge of it and that he was convinced his members were contributing their share of federal taxes.

I wish to thank you, Madam Chair, for this opportunity to keep my promise.

[English]

The Acting Chair (Mrs. Karen Redman): Thank you, and my apologies. Monsieur Loubier asked to table that document earlier.

Mr. Kyle, you may begin.

[Translation]

Mr. Kenneth Kyle (Director of Public Issues, Canadian Cancer Society): Good morning,

[English]

Madam Chair, members of the committee. You received a copy of our submission earlier. I have circulated today, in both English and French, a copy of my speaking notes, and I will be very brief. I will even abbreviate those notes as well.

I think we all know that as Canada's population grows and ages, we have an increasing incidence of cancer. We're pleased to see that a cancer control strategy for Canada is being developed, and there is a small secretariat at Health Canada working with a number of groups. It's essential, we believe, that Health Canada have the resources to continue to participate in the development of a nation-wide cancer control strategy.

With regard to CIHR, leaders from the Canadian Cancer Society, a national cancer institute of Canada, played a major role in the 1998 task force, which took on the task of determining methods to strengthen health research in Canada. The Canadian Cancer Society is extremely pleased that the federal government agreed with the recommendation of the CCS and many other groups and announced the creation of CIHR in the 1999 federal budget. This is a bold step in the right direction and will have far-reaching impacts on the creation of new knowledge and innovation in the health research field.

The role of the federal government is a fundamental component in supporting the broad base upon which we build our cancer-fighting research and programs. We believe this investment in health research will help stem the flow of talented researchers to other countries.

I want to talk a little about tobacco taxes. I'm sure members of the committee are aware that we are disappointed at the small size of the tobacco tax increase announced by the Minister of Finance on November 5. However, this committee has been consistent in recommending higher tobacco taxes each year, and I congratulate you for that.

I want to point out that the Americans have demonstrated that it is possible to have high cigarette prices, even $48 a carton in New York or $51 in Michigan, without contraband entering the country. If the United States can do it, so can Canada. We recommend that the next tobacco increase be contained in the forthcoming federal budget.

We support the government's announcement in the 1999 budget to require province-specific, tax-paid markings on tobacco packages. However, no regulations have yet been implemented. We urge you to encourage the government to enact regulations for effective new markings as soon as possible.

We were pleased that the surtax on tobacco manufacturer profits was made permanent. The increased revenue from the tobacco tax increase and making the profit surtax permanent provide new financial resources for the government to increase its tobacco control efforts.

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Along that line, I would point out that the federal government each year receives over $2 billion in tobacco taxes, including an estimated $85 million from illegal sales to children. The government also collects $70 million from the health promotion surtax on the tobacco industry, which I have just referred to. Next year the government will receive another $70 million a year from the recent tobacco increase.

Less than 1% of this revenue goes into strategies to reduce smoking. We recommend that the budget allocate $240 million a year for all federal tobacco control programs. This would include the $120 million for a government replacement for Bill S-13, promised last January by Minister of Health, Allan Rock.

Finally, we urge you to support the voluntary sector. If groups like the Canadian Cancer Society did not exist, governments would be under pressure to provide a higher level of programs and services. As the governments cut back services, greater demands are made on the voluntary sector. We recommend new tax measures that would encourage modest donors to increase donations.

Finally, in order to keep a priority on health wellness as well as health care, it is essential that Health Canada be provided with adequate funding to carry out its mandate in full. We recommend a general increase in Health Canada's budget of $150 million a year for a minimum of five years.

Thank you, Madam Chair.

The Acting Chair (Mrs. Karen Redman): Thank you very much. We'll now hear from Mr. Lefever from the Heart and Stroke Foundation of Canada. Welcome.

Mr. Allan Lefever (Volunteer President, Heart and Stroke Foundation of Canada): Good morning, Madam Chair.

[Translation]

Our mission is to further the study, prevention and reduction of disability and death from heart disease and stroke, through research, education and the promotion of healthy lifestyles.

[English]

We appreciate this opportunity to appear before you, and we believe this consultation is vital to both the health charities and the government. We commend the government for its investment in health during last year's budget, specifically the investment in the Canadian Institutes of Health Research. We support Deputy Minister Dodge's call that this transfer of funds into the health budget improve the health of Canadians.

The Heart and Stroke Foundation is working in cooperation with the Laboratory Centre for Disease Control on surveillance activities to measure whether the strategic reinvestment is indeed contributing to and helping the health of Canadians.

There are really three points I want to address with you this morning: tax incentives for those who care for disabled relatives at home; the need for a fund to support community-based programs; and a revitalization of Health Canada's investment in its voluntary sector.

Heart disease and stroke represent the leading cause of death in Canada today. We estimate that for the most recent year for which data is available, cardiovascular disease was responsible for almost $20 billion in direct and indirect health care costs.

It is also of concern to us that a growing number of Canadians are living in a state of disability as a result of congestive heart failure. The burden of that is being carried by many other Canadians in the form of being informal caregivers, providing care for parents and relatives who are discharged early, or who have and suffer from congestive heart failure or other disabling diseases.

Improved tax credits that were introduced were a good beginning. We suggest they need to go further. They can reduce the financial hardship experienced by these informal health caregivers by providing an integrated home care program. We suggest that needs immediate attention.

Health charities have had a great deal of success in interacting with Canadian communities and they provide many outreach programs. We suggest there is an abundance of under-utilized capacity in that area, and measures should be adopted to assist the Canadian public in becoming self-sufficient in the ways they deal with their health concerns.

The establishment of a health charities community outreach programs enhancement fund that could be administered by an arm's-length independent agency would be a measure in that direction. That program and fund would be used to expand effective community-based programs that are of a national level, such as—and I only use this as an example—the Heart and Stroke Foundation's CPR training program, automated external defibrillators training, and the Heart to Heart program. There are a vast number of programs of many of the health charities that can be enhanced. They've proven effective and they can work in the community, with help.

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Madam Chair, we also want to draw to the committee's attention the fact that the federal government's recent program review eliminated or substantially scaled back many health charity sector initiatives across the country that were and still are in high demand. With the restoration of our fiscal health, we suggest the time is opportune for a strategic reinvestment in those initiatives. To that end, Madam Chair, we support the pre-budget brief that was submitted by the National Voluntary Organizations Working in Health, in which a call was made for a reinfusion of moneys that were removed from Health Canada's core budget during program review. We recommend that this proportion of the budget be reinvested and restored.

Before concluding, Madam Chairman, I also want to indicate that the Heart and Stroke Foundation supports the increased investment in tobacco control through Bill S-13 replacement legislation and joins with the Canadian Cancer Society in making that recommendation that is found in their brief.

[Translation]

With the return of Canada to financial health, the time is ripe for continued reinvestment in the health of Canadians. The health charities sector must be assisted to enhance and sustain its capacity to deliver the services and programs that the people of Canada have come to depend on. This reinvestment is necessary to strengthen the social fabric of our country and put Canada on a strong footing for the 21st century. Thank you.

[English]

Madam Chair, thank you. I would be pleased to answer any questions.

The Acting Chair (Mrs. Karen Redman): Thank you very much.

We'll now hear from Mr. David Hill, chair, and Mr. Pierre Cadieux, executive director, for the Council for Health Research in Canada.

[Translation]

Mr. David Hill (Chair, Council for Health Research in Canada): Good morning, Madam Chair, members of the committee. My name is David Hill.

[English]

I'm the volunteer chair of the Council for Health Research in Canada. Mr. Cadieux is our executive director. I will make a brief statement. Mr. Cadieux will not make a statement, but will be able to assist if there are questions.

The council is composed of most of Canada's privately funded health research institutes and voluntary health organizations. The spokesmen for the last two organizations were from the Cancer Society and the Heart and Stroke Foundation. Both of those organizations are members of our council. So it bridges the health research scientist in a research institute with the voluntary organizations that provide a considerable amount of funding for health research in this country.

Our members' research activities cover a wide range, running in a spectrum from genetics and the genome project to cancer, heart to arthritis, or cystic fibrosis to women's and children's health. Our council was created in 1993 for the purpose of building a bridge for a sustained policy dialogue with the Government of Canada, and our mission is the ongoing promotion of health research.

Health research represents an investment in Canada's future not only in terms of benefits to the health of Canadians and the nation's health care system, but also in terms of job creation and in a number of health care and science-based industries. We also champion the cause of health care outcomes research and evidence-based medicine, so that health research is understood by all as generating cost savings rather than simply being a cost to our health care system.

Health researchers consider the federal government's role as the leading and base funding player. Other voluntary health agencies rely on the core of investigators and programs supported by government and use their funds in a complementary fashion. The government's role is a fundamental component of support of the broad base upon which volunteer funding agencies build disease-specific programs. For example, 60% of cancer research in Canada comes from public fundraising. However, more financial effort must be made by the government if we are to attain matching levels of federal funding comparable to our neighbours to the south, where, for example, 90% of cancer research comes from U.S. federal government funding.

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Our health care system is a cornerstone for our country. It's crucial because it has put the government in a position of having an overall view of the science and the voluntary activities in the health sector. A weakening of that role can threaten the effectiveness of support being derived from other sources—such as the voluntary health agencies—and it affects the entire research enterprise.

Today we look to the future of health research with more optimism than we have seen for many years. In 1998, the Minister of Health's task force advising him on future health policies and initiatives resulted in an impressive series of health policy initiatives in the February 1999 budget. We would compliment the government for those initiatives.

The creation of the Canadian Institutes of Health Research is a very major step in the right direction. It sends the right message: that investment in health research saves lives, saves money, retains top researchers, attracts youth to research careers in this country, and increases translational applications in the biotech and pharmaceutical industries.

Research jobs and infrastructure are created and add to the critical mass needed to attract further investment in the country's economy. Major cost savings are derived from medical and health advances. There are economic returns not only from increased productivity by reducing the burden of disease and disability, but also in the development of actual research industry jobs. For example, it's been estimated that renal transplantation research over a period of some nineteen years has resulted in annual savings to the country of about half a billion dollars.

The benefits of health research are realized on several levels: improving diagnoses, treatment, prevention of disease and disability, enhancing the quality of life through increases in functional capacity, reduction in pain and suffering, advancing public health, and contributing to a stronger economy through health care savings and through increased productivity.

The new health policy thrust from Ottawa now gives more impetus to fighting to control reduced health care costs. This means not only basic research into the prevention of disease, but research into the health care system itself to ensure the most effective use of our health care dollars. The council encourages the federal government to pursue the need to assess and evaluate new medical advances to be introduced into the health care system. For example, about 60% of medical procedures have never been subjected to examination through an evidence-based system of analyzing outcomes and effectiveness. There is much more research that is required.

Madam Chair, Canadian health research has produced many outstanding achievements over the past decades. We are now in a position to go forward to develop additional world-class research and discoveries that will impact on the quality of life of Canadians and act as a strong engine of growth for the new knowledge-based economy. The government must continue to work closely with health researchers and the voluntary health community to establish goals and objectives in the long run that will produce this advantage for health research.

Thank you very much. We'd be pleased to answer any questions.

The Acting Chair (Mrs. Karen Redman): Thank you.

We'll now hear from Dr. Barry McLennan, chair, and Mr. Charles Pitts, executive director, from the Coalition for Biomedical and Health Research.

Dr. Barry D. McLennan (Chair, Coalition for Biomedical and Health Research): Thank you, Madam Chair. Thank you for inviting CBHR once again to speak to your committee. As you mentioned, I'm joined today by Mr. Charles Pitts, the new executive director of CBHR. Our brief, entitled “Building the Health Research Environment”, has been distributed to your committee.

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As you know, CBHR represents over 40,000 health researchers and clinicians in Canada. Our objectives are very simple: one, to increase the public awareness of the benefits of science; and secondly, to ensure there's adequate funding in Canada for health research.

Three weeks ago, the Honourable Paul Martin, Minister of Finance, delivered his economic and fiscal update to this committee. In his update the minister outlined several crucial requirements for ensuring Canada's leadership position in the emerging global economy. Three of these requirements are of particular interest to the health research community, represented by CBHR, and I'd like to speak to them briefly.

The three requirements are: first, the need for tax reductions to promote economic growth; secondly, the need to promote and support innovation; and thirdly, the need to invest in the development of our human resources through skills training and education.

On the first requirement, there's a growing consensus that taxation levels must be reduced in order to maintain economic growth, to improve our productivity, and to reverse the brain drain in Canada. The burden of personal income tax is particularly relevant in the scientific research community. Knowledge-generating research is a globally competitive enterprise in which the impact of income tax levels plays an important role in determining whether one chooses to pursue his or her career in Canada or elsewhere. In our brief I refer you to the UBC Alumni Association survey, which documents this.

Canada is becoming a training ground for our best and brightest. We lose five researchers to the U.S.A. for every one who comes back. The federal government must acknowledge that the brain drain is real, is very costly, and represents an urgent policy priority. I spoke in great detail on this issue to your committee in May, Madam Chair.

Reducing the burden of personal income tax then is a key factor in building a health research environment in Canada. Our recommendation on page 3 in the brief asks for the federal government to develop for individuals a comprehensive tax incentive program that will stimulate investments in our health technology sector.

In Canada we have an enviable quality of life and a reputation for world-class research. The Canadian tax regime must be restructured in a more competitive manner relative to the global research community, or we will continue to export our brightest and best minds.

The second of the three crucial factors is the need to promote and support innovation. Let me commend the Government of Canada for the steps already taken in this regard, namely: the establishment of the Canada Foundation for Innovation, with additional funding announced in the February 1999 budget; the endorsement of the CIHR concept with legislation introduced on October 12, Bill C-13; and the recent announcement by the Prime Minister to establish 2,000 research chairs in our universities.

I spoke to this committee earlier on the need for an organization like CIHR, and I thank this committee in particular for its support of this initiative. CIHR is transformative and innovative. It will help reduce the brain drain, it will increase our competitiveness, and it will provide better health care to all Canadians. I urge you to remind the government to continue to expand its support for CIHR with the objective of matching the average annual increments for health research provided by our competitors.

The broad challenge here is clear. We must develop a coordinated national innovation strategy. Again, to quote the Minister of Finance:

...all of us have a role to play in building an economy that can innovate and compete with the best in the world.

Intellectual property protection is another key area where the federal government must ensure that Canada's regulatory environment remains competitive with our G-7 trading partners. Our recommendation on page 7 asks for a separate agency to be established outside the Health Protection Branch to undertake the review and approval of health and biotechnology products. Our recommendation also asks that the Patent Act be revised to ensure harmonization with the intellectual property laws of international competitors, including the provision of patent term restoration mechanisms to compensate for delays caused by regulatory review.

The third factor in ensuring Canada's leadership position in the emerging global economy is the support of skills training and scientific education. CBHR is pleased that the Minister of Finance has made education a clear priority, and I commend the government for its Canada opportunities strategy and its efforts to ensure that every school in this great country will have access to the Internet.

In conclusion, CBHR stresses the necessity of building the research environment in Canada. Three crucial requirements deserve attention: tax restructuring, reversing the brain drain, and encouraging innovation.

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Much has been done. Much more remains to be done. And as Minister Martin stated a few days ago, and I quote:

In these—the closing days of the 20th century—Canada has a unique opportunity to take hold of its destiny. To translate better finances into better lives for all.

Thank you, Madam Chair. Mr. Pitts and I are prepared to answer any questions.

The Acting Chair (Mrs. Karen Redman): Thank you very much.

We'll now hear from Mr. Don Moors, member of the board of directors, and Ms. Kathryn Maclean, executive director of Sidelines Canada.

Welcome.

Mr. Don Moors (Member, Board of Directors, Sidelines Canada): Thank you, Madam Chair, and thank you for the opportunity to appear before your committee as part of its pre-budget consultations.

We're here today to discuss an issue with significant consequences for our children and our country: prenatal health and the unacceptably high rates of preterm birth in Canada.

First I'll give you some background. Sidelines Canada was established in 1998 as a resource for women and the families of women who are experiencing high-risk pregnancies. High-risk pregnancies are defined by the medical profession as pregnancies in which women experience one or more medical complications that put their health or the health of their babies at risk.

Sidelines Canada is the only national charitable organization in the country that offers mentoring services, educational information, and other support to the over 100,000 women who experience a high-risk pregnancy in Canada each year. We are funded almost entirely by individual, corporate, and foundation donors.

Sidelines was established through the perseverance and dedication of our executive director, Kathryn, who during her pregnancy in 1997 was diagnosed with preterm labour and spent eighteen weeks confined to bed rest before giving birth to a full-term, healthy baby girl named Emily.

I'd like to ask Kathryn to share with you some background and facts on high-risk pregnancies and preterm birth.

The Acting Chair (Mrs. Karen Redman): Thank you, Don.

Ms. Kathryn Maclean (Executive Director, Sidelines Canada): The months I spent confined to bed rest proved isolating, frightening, and confusing as I worried about the health of my baby. Most disturbing to me was the fact that after being diagnosed, I found no support or information from a Canadian health care perspective to explain what I was going through our how it affected my baby.

This lack of support and resources was even more disturbing when I learned that 20% to 25% of all Canadian pregnancies are considered high-risk at some time. And of course I'm not here just to speak to you about my own experience. Since starting Sidelines, I've spoken to hundreds of these women, and the fear, isolation, and frustration I experienced are virtually universal.

One of the biggest risks in most of these high-risk pregnancies is preterm birth. In Canada preterm birth rates are on the rise even as we are being hailed as the best country in the world in which to live. In 1994, which is the last year for which we have statistics available, Canada's preterm birth rate reached an unacceptably high 7.3%, and our rate continues to exceed that of many other developed countries.

Preterm birth has dramatic and often catastrophic consequences. It remains the greatest cause of infant mortality and morbidity in North America. In addition to the emotional and personal consequences, the economic consequences are also staggering. A new study to be released by the Society of Obstetricians and Gynaecologists of Canada finds that preterm birth, over the lives of the babies, costs Canada $13 billion each year.

Although the cause of preterm birth is complex and still unclear, the much lower rates in other countries suggest that up to 50% of preterm births in Canada are preventable.

Unfortunately governments have adopted a fairly limited approach in tackling this problem. The only federal government program dedicated to addressing prenatal issues is the Canada Prenatal Nutrition Program, or CPNP, which provides resources for locally based projects that help low-income women with issues such as poor nutrition and alcohol, smoking, and drug addictions.

This program, while certainly important, really only addresses a narrow component of prenatal health issues in Canada. Departmental statistics indicate that the CPNP targets only 10% of the pregnant population—well below the 20% to 25% of pregnancies considered high-risk in Canada each year. Many of the CPNP's target clientele do not even experience a high-risk pregnancy as defined by the medical profession.

There are no programs dedicated to addressing the broad range of medical complications that give rise to preterm birth. For example, funding is unavailable for programs to assist and support women experiencing high-stress or multiple pregnancies, which together account for 26% of all preterm births.

Governments can and must do more. Specifically, additional resources are required in the following three areas.

First, more education is required for patients. Women who have information about their condition available to them are more likely and more able to comply with difficult, restrictive treatment regimes. Increased information also alleviates some of the stress that can result from knowing your baby is at risk and therefore decreases the preterm birth rate.

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Second, more support networks are required. Medical research indicates that personal, nurturing support can also help to reduce preterm birth. It's simply unrealistic to expect that this support can be provided within the health care system as it exists.

Finally, more research is required. There is simply so much more to learn about preterm birth and its prevention.

Mr. Don Moors: With increased surpluses available, we believe now is the time for the federal government to show leadership and commit resources to addressing a broader range of prenatal issues. While the current CPNP is to be commended, it only addresses an extremely small part of the problem. Simply adding more dollars to this program ignores many of the pressing problems that contribute to high preterm birth rates and other prenatal risks.

Therefore, we are asking this committee to recommend the creation of a new prenatal program, the Canadian prenatal education, support and research program, which would be dedicated to addressing a broad range of prenatal health issues. The program would make resources available for the projects that address the three needs identified above and which are explicit in its name: education, support, and additional research information.

The program should be structured to maximize partnership initiatives with NGOs such as Sidelines, as well as with other levels of government and the private sector. In our view, this type of program must be a key part of any children's initiative the federal government may be considering.

As an alternative, if the committee cannot make such a recommendation, we believe at the very minimum it should acknowledge the severe nature of the problem of preterm birth in Canada and identify it as a future priority initiative.

Thank you for your time. Kathryn and I would be pleased to answer any questions you may have.

The Acting Chair (Mrs. Karen Redman): Thank you very much.

We'll now hear from Ms. Nickie Cassidy, national social action volunteer, Multiple Sclerosis Society of Canada.

Ms. Nickie Cassidy (National Social Action Volunteer, Multiple Sclerosis Society of Canada): You've just taken away my introduction, Madam Chairman. I am Nickie, or Monique, Cassidy, as you prefer. I do have MS, and I am here to represent the MS Society. We thank you for giving us this opportunity to address all of you.

We're here to tackle what we believe are the issues that would enhance the quality of life of people living with MS. It's our understanding that several of the proposals are supported by other national voluntary health organizations. Indeed, I've heard a few of the points mentioned here this morning.

There are four broad headings, the first of which is tax relief and reform. The disability tax credit is a great cause of concern for people with disabilities. We need to have the government introduce a fairer definition of disability to cover individuals with a continuous or recurrent disability that is expected to last one year or more. The current definition excludes many people with MS, who have very high disability-related expenses, because their disability is cyclical or recurrent and not continuous.

We support the recommendation by the 1997 federal Task Force on Disability Issues to introduce a new refundable disability expense tax credit to replace the disability tax credit and the medical expenses tax credit and to increase the tax rate used to calculate the credit from 17% to 29% for low-income beneficiaries.

We'd also like to see for charitable donations the tax incentives enhanced for modest-income donors, in other words, those whose total donations are $2,500 or less a year. Most of the people who donate to the MS Society do so within their means, but we're looking at donations of $25, $35, and $50 per year. These people get very little for that and need encouragement to give more. If you want us to provide more services to the people, we need more money.

Social infrastructure. Under the CPP disability benefits, again we have a problem with the definition of disability. We need to have you introduce a fairer definition of it as well in order to cover individuals with a continuous or recurrent disability that is expected to last one year or more. This change would make the definition of disability more consistent with disability income support program eligibility criteria in other jurisdictions.

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As an example—which I was asked to give last year and couldn't, but here it is—under part I, section 4, of Bill 142, the ODS Act, a person qualifies as a person with a disability if the person has a substantial physical or mental impairment, the impairment is continuous or recurrent and expected to last one year or more, the impairment results in substantial restrictions in one or more activities of daily living, that is, personal care, functioning in the community, and/or functioning in the workplace.

Another large problem with CPP is that people with multiple sclerosis who apply for CPP disability benefits are by and large turned down immediately. You look at me and figure I'm not disabled enough to get a pension plan. So people appeal. Currently, this takes not weeks or months but years.

This is most unfair to people with disabilities. It's bad enough that you're living with a kind of illness that is certainly lasting. It's not going to go away. Our whole raison d'être, if you will, is that we raise enough money and find the cause of and cure for MS, but until such time as that happens, it's not going to go away.

We'd like to see the lengthy application and appeal processing delays we currently experience reduced to 60 days. Here we're being very generous. We've asked in many other jurisdictions that those 60 days be 30 days in most cases. We're trying to be reasonable. We'd also like to see internal reviews completed within 60 days of receipt of a request for reconsideration and decisions of the tribunal rendered within 60 days of an appeal hearing. I think that's just a little fairer.

Another aspect of the CPP is that once you get CPP benefits, you're supposed to be totally and completely disabled. That is not the case for a lot of people. Just because you have a continuous disability doesn't mean you're worthless. Some people can do part-time or occasional work, and this should be allowed. There are a few cases right now where exceptions are being made, and these should no longer be exceptions. They should be the rule. It makes people feel much more worth while if they're able to earn some money and to do certain things. Currently if they try to do this, of course they're simply cut off.

The last point under the CPP is to change the contribution rules to allow applicants to have their best years rather than their last years of contributions determine their eligibility. Currently, when pension plans are being calculated for federal government employees as well as for most employees of major firms, it is not the last five years that are considered, it is the best five years.

In the case of the CPP the program looks at the last five years. In the case of MS, when they're first diagnosed, many people figure and are told, and it frequently happens, this is going to get better. There's a good chance you can carry on. So they carry on. They do try for the longest time to keep working. In many cases, at the end of a certain period of time, they find they can no longer work. In many cases this means they are no longer eligible at all for CPP. In many of the other cases it just means that the last five years they've worked are probably the least fruitful of their entire working career, including sometimes their student days. It's an issue that's very close to our hearts.

Under health infrastructure—I'm trying to keep this a little shorter because I've gone on a bit—I will just simply say that we need equitable protection against catastrophic drug costs across this country. It's absolutely ludicrous when I looked at this chart and found the costs of catastrophic drugs for MS can be $17,000 or $18,000 a year. That's an awful lot of money.

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If you live in the province of British Columbia, you're asked to pay up to $2,000 per year. Some low-income people pay a maximum of $600, but there are many conditions.

Each and every province and territory across this country has different levels of reimbursement. I guess I'd have to move to Nova Scotia, if I wasn't too old to get the drugs in any case, because in that province people are asked to pay $34.60.

That's quite a variety of reimbursement for people who are suffering from an illness for which there are now medications that allow them to carry on a very normal life, to work full-time in many cases, to pay taxes, and not be dependent on the system but rather contribute to it. But it depends on where you live, whether or not you're eligible for the reimbursements. I'm quite well aware this is a provincial matter, but I think we have to do something to start getting some leadership here and some across-the-board...not rules or regulations, but maybe kind words or pushing or whatever needs to be done to have this happen.

The last item is on medical research, and we've already heard a great deal about that. The MS Society very much welcomes the federal government's introduction of the legislation and the CIHR is one of the items that we address, as other groups did last year. The one thing we would like to see is that the structures be inclusive of and transparent to ordinary Canadians who are affected by health issues in their day-to-day lives and include a leadership model of a governing council of two vice-chairs in addition to the chair.

In conclusion, I'd like to thank you all.

[Translation]

We thank the committee for this opportunity to present the concerns of Canadians with multiple sclerosis and trust that our suggestions on how the federal government could improve the quality of life of people affected by MS will be given due consideration in the upcoming federal budget. Thank you very much.

[English]

The Acting Chair (Mrs. Karen Redman): Thank you.

We'll now hear from Ms. Penelope Marrett, director, health issues, from the National Voluntary Organizations. Welcome.

[Translation]

Ms. Penelope Marrett (Director, Health Issues, National Voluntary Organizations): Good morning, ladies and gentlemen.

[English]

Thank you for the invitation to appear before you today.

[Translation]

I am here today to represent the national voluntary organizations working in health. The voluntary sector in Canada is thriving, responding to the needs of the people of Canada coast-to-coast. It is a complex sector, which is often considered to be the third pillar of society. The sector has $90 billion in annual revenues, with $109 billion in assets. This is comparable to the size of the economy of British Columbia and accounts for 1/8 of Canada's Gross Domestic Product. About 60% of the revenues in the sector are in teaching institutions and hospitals.

[English]

National Voluntary Organizations Working in Health represent a vast array of organizations that provide programs and services coast to coast through local communities and networks. Organizations such as the Canadian Cancer Society, Canadian Celiac Association, Canadian Women's Health Network, and YMCA Canada are just a few examples of those organizations whose primary focus involves the health of the people of Canada. National Voluntary Organizations working in health are all committed to maintaining and improving the health of the people of Canada.

[Translation]

In recent years, the federal government has publicly renewed its commitment to the voluntary sector. The government is to be commended for the commitments it has thus far made to the sector through such mechanisms as increases in tax incentives to donors, establishment of the VolNet programme and, most recently, the Joint Tables process initiated by the Privy Council Office. Such initiatives have helped to strengthen and deepen the dialogue between the federal government and the voluntary sector.

[English]

Health is top of mind for ordinary Canadians. Poll after poll indicates people from coast to coast are concerned about ensuring that Canada has the best possible health system.

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National Voluntary Organizations working in health are a critical part of the health system. The investment in health by the federal government in its 1999-2000 budget is to be commended, including the Canadian Institutes of Health Research and the financial contribution to the Canadian health network. Programs and services offered through the sector enhance the ability of the people of Canada to maintain and improve their health.

We would strongly urge the government to implement the following recommendations.

[Translation]

Further enhance tax measures for modest donors, that is, individuals who donate $2,500 a year or less.

[English]

Increase funding for Health Canada by $150 million per year for a minimum of the next five years for disease prevention, health promotion, public involvement, health information programs, and an evaluation process developed in concert with key stakeholders, including National Voluntary Organizations working in health.

And lastly,

[Translation]

support the increasing needs of the voluntary sector to become connected to the information highway through an expanded VolNet programme for the next five years. Thank you.

[English]

Thank you.

The Acting Chair (Mrs. Karen Redman): Thank you very much. We'll now go to a seven-minute round of questioning. We'll start with Monsieur Loubier.

[Translation]

Mr. Yvan Loubier: Thank you for your presentations. I would like to ask a few general questions. I think that it is the representative from the Canadian Cancer Society who mentioned the revenues that the federal government receives from the tobacco industry every year. We are talking about $2 billion in tobacco taxes, including an estimated $85 million from illegal sales to children. The government also collects $70 million from the health promotion surtax on the tobacco industry. Next year the government will receive another $70 million more from the recent tax increases on tobacco.

If this information is available, I would like you to emphasize not only the federal government revenues but also the costs of smoking for society every year. I think that it would be a good way to promote the weeding out of this bad habit and probably to demonstrate that if the federal government can receive over $2 billion a year, the costs associated to tobacco use are astronomical.

Mr. Kenneth Kyle: Yes, thank you.

[English]

Thank you very much.

Some of you may have seen the ad we published in The Hill Times this morning because we wanted every member of Parliament to be aware of the current situation. Of the tobacco industry's new customers, 85% are children, and since the tobacco tax rollbacks of 1994 and the half-price cigarettes, we've seen a disturbing rise in smoking amongst kids. So we've pointed out, as I've said earlier, the federal government gets $2 billion a year from tobacco taxes. That includes $85 million from taxes from illegal sales to kids, kids who buy cigarettes who supposedly aren't allowed to buy them. The government gets $85 million a year from that source.

The government also collects, per year, $70 million for the health promotion surtax, which is a tax on the tobacco companies for health promotion. As I mentioned, we're very pleased the Minister of Finance announced that this surtax would be made permanent. The small increase in tobacco taxes that was announced recently will bring in another $70 million a year.

What can be done? There have been some very successful experiments in other jurisdictions. The State of Massachusetts, for example, spends the equivalent of $8 Canadian per capita on tremendous programs, where they have media programs, anti-tobacco ads on television. We're starting to see a few here in Canada, but Health Canada does not have the resources to buy enough time to really show them to reach all Canadians.

We think Bill S-13, the Tobacco Industry Responsibility Act, was a great idea. That was declared out of order on a technicality in the House of Commons. But to do something like the State of Massachusetts has done—we think this could be done for $240 million a year. For starters, the committee could recommend proceeding with the $120 million just for the media component that Bill S-13 would have seen. Health Minister Alan Rock promised a government replacement for Bill S-13 during the big speech he gave at National Non-Smoking Week last January.

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Tobacco is bringing huge amounts of revenues into the government. It's a drain on our economy. It's a terrible health problem. The incidence rates of cancer would be looking a lot different if we factored out cancers related to the use of tobacco industry products—cervical cancer, lung cancer, and other cancers. We would see a totally different picture.

Can you imagine what we could do in this country if we could beat this one problem that's causing one-third of all cancer deaths? Just think of the resources we could put into breast cancer, skin cancer, stomach cancer, and so forth. We think it's an investment. By putting some of the tax money the government does receive back into preventing smoking, we think we can actually save health care costs down the road. California, Massachusetts, Florida, and other jurisdictions have shown that programs can work.

[Translation]

Mr. Yvan Loubier: Do we have an evaluation of the annual costs associated to smoking that we could compare directly to government revenues? You are saying that the government receives an incredible amount of money from the tobacco industry but if the costs are two or three times higher, in net terms, the tobacco industry is costing the government a huge amount of money. The recent schemes of the tobacco industry that were highlighted regarding additives and market research to target younger and younger customers and get them hooked require that we consider this issue a little more seriously and that we become more coercive than ever with this killer industry.

[English]

Mr. Kenneth Kyle: It's been a few years since a very good study has been done by Health Canada, but I can provide that information to the committee. It's substantial, and I'll get back to you on that.

The Acting Chair (Mrs. Karen Redman): Monsieur Loubier, do you have an additional question?

[Translation]

Mr. Yvan Loubier: Yes, I have another one. I think that it was Dr. McLennan who told us that we have to harmonize our intellectual property laws with those that exist elsewhere to avoid Canadian patents running into problems abroad. Can you tell us what is wrong with the Canadian Health Patent Act?

[English]

The Acting Chair (Mrs. Karen Redman): Dr. McLennan.

Dr. Barry McLennan: Thank you. The issue is quite simple in this way. Canada is a competitor globally for our research products and for our research activities and so on. If we want to attract foreign investment into our research enterprise, we have to be competitive. There are many factors that come into defining and characterizing our research environment in Canada.

If, for example, we want to encourage investment by the global pharmaceutical industry in this country, and many would agree we should.... Indeed, they invested about $850 million last year in Canada and much of that is for basic research, which I think we would all agree is important. If we want to attract that kind of investment we have to have a competitive environment. The Patent Act harmonization is one piece of that. Taxation, in general, is another piece of it. Having a cadre of well-trained researchers and scientists in this country who can do the research these companies would like to have done is another factor. So the harmonization with other countries is simply one piece of the requirement to make it a level playing field.

The Acting Chair (Mrs. Karen Redman): Thank you.

Mr. Szabo.

Mr. Paul Szabo: Thank you.

Mr. Lefever, you were talking about the tax credit for those who provide care to family members in the home.

Mr. Allan Lefever: Yes.

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Mr. Allan Lefever: Yes.

Mr. Paul Szabo: As you know—I think it was in 1997—the government made a commitment to that and actually introduced a caregiver benefit. In my view, it was somewhat modest, but it's good to have your foot in the door. Do you have an idea of what you think should happen to that? Should changes be made there just in terms of dollars, or should the scope of the benefit be adjusted?

Mr. Allan Lefever: Mr. Szabo, we were pleased to see that introduced. I think it was in the 1998 budget, and we're pleased to see a recognition of the need. The benefit is, by any measure, modest, and in our view it simply doesn't recognize the fact that the burden falls on the low-income earner to provide this kind of care and that there's an economic deprivation to the couple or the family who have to provide this care.

We don't have a figure that we would suggest, other than that it should be increased. The recognition should be that it needs to be improved beyond either the percentage in relation to income or the actual amount. In our view, it's simply too low.

Mr. Paul Szabo: Today in the newspapers there was quite a substantial report on the cost of home care, institutionalized versus informal. On its face it certainly did look attractive, but in my reading of it, it didn't seem to attribute any value to family members having to be involved whatsoever.

It seems to me that women particularly are closer to their parents than men would be, and if there was a need even to supplement that home care, it would probably be women who would have to do it. I'm sort of curious as to whether or not that was your reading.

Mr. Allan Lefever: Mr. Szabo, I was only made aware of the report in the Globe this morning. I haven't had an opportunity to read it. I was told that one of the conclusions that was articulated was that it cost half as much to care for somebody in the home as it did in an institution.

Quite frankly, I would think that any person providing home care to a family member who was told that work was of little or no value would take issue strongly with that and, indeed, if it wasn't in a room such as this, would want to do rude things your body. It's simply unreasonable and unfair to say that. It's a tremendous burden and a tremendous sacrifice that is made by people who provide that.

Mr. Paul Szabo: Thank you. It's good to have that on the record because there certainly is an importance to be applied to the home care element, simply because everybody doesn't live in urban centres. Affordability and accessibility are issues that...people may not be able to get over that hurdle.

I give you full marks for bringing that again to the attention of the committee, and I encourage the researchers to please take note of the caregiver tax credit, which we did bring in, in 1998. It is clearly a very modest amount, a starting point only. I would certainly support an increase in that, and I hope we can support that in our report.

My last question has to do with Sidelines. It's terrific that there are groups here. It's amazing how many groups are started because of personal experience. You wonder where they were all along.

I wonder, Kathryn, have you any idea what it costs for a premature child? What does it cost our health care system, on average?

Ms. Kathryn Maclean: My understanding is there was a study done at the Ottawa Hospital a little while ago that looked at babies born in different ranges of weeks. It depends, of course, how premature the baby is, but just to get the baby home from the hospital, not looking at lifelong consequences for that baby, it was up to about $65,000. That didn't look at mom's care in advance of the baby's birth either. So that's for one infant.

Again, the SOGC study that's coming out suggests it's $13 billion a year when we look at all of the babies and the lifelong consequences of preterm birth.

Mr. Paul Szabo: The education component seems to be part of the solution to most of our health problems—no question about it. Why is it that the medical profession has not stepped up—indeed, I guess even the provincial governments—in terms of even producing the kind of information that would be fundamental to help people identify their risk or at least seek references to get some help if they are concerned or having some problems?

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It seems so obvious. Yet, as an example, I remember Claudette Bradshaw, who's now the Minister of Labour, in her previous life was working with the National Crime Prevention Council. She was working with parents of children who had fetal alcohol syndrome. She came before our health committee, and I remember asking her how many of those parents knew what FAS was, and she said sadly, very few.

I have a feeling the same kind of thing you're experiencing or that you know about, the risk factors, the signs, the kinds of fundamental knowledge, just doesn't seem to be out there. Who's failing here? Why don't Canadians know the kinds of things they should know so that we can all benefit from lower health care costs?

Ms. Kathryn Maclean: Thank you for the question, Mr. Szabo.

I think in large part health care providers are trying to address the concerns they see as possibly relevant for the individual who is sitting in front of them. However, of course, there are a lot of issues that arise in prenatal health care, and I think there is simply a lack of resources. There are not enough obstetricians in Canada. There are a decreasing number of physicians delivering babies, so the strain on the health care system is simply perhaps too great for them to be able to spend the amount of time they would need to spend with each patient to be sure she was aware of all of the different possible complications that could come from her pregnancy.

I think there's a role to be played here from a population health perspective, if we can educate people generally. People are astonished to learn that one-quarter of all pregnancies are considered high-risk at some time. Women are astonished to find themselves in that position when they don't think of themselves as someone who was predisposed or at risk before the pregnancy to have problems. So if we can educate people from a population health perspective about the risks, and about the fact that pregnancy is not all about working until the day you can deliver the baby, and jogging, and having a nice, healthy lifestyle, that there's more to it than that, then perhaps we can address it in a more-cost effective and efficient way.

Mr. Paul Szabo: Thank you.

Madam Chair, that concludes my questions. When we do these hearings and we come across issues like this, I think it's important to earmark them. I for one would encourage the research staff to seriously consider putting into the report somewhere even that bald statistic that up to 25% of pregnancies could be considered high-risk. We all benefit when we have healthy outcomes for children. This is certainly an area that I think deserves the attention not only of moms but of the researchers and the health care community at large, as well as pretty well all Canadians. I think it touches all of us, and I think it certainly would be a healthy addition to our finance report on prebudget....

The Acting Chair (Mrs. Karen Redman): Thank you, Mr. Szabo.

Ms. Leung.

Ms. Sophia Leung (Vancouver Kingsway, Lib.): Thank you, Madam Chair. I want to thank you all for sharing your ideas and concerns.

Before I became an MP, I was very involved as a volunteer. I worked for cancer and also the Heart and Stroke Foundation as a fundraiser. So I have some idea of the difficult task you people are involved with.

I have a couple of questions. I think my colleague already discussed caregivers a little. What role do you think we really have to look into to consider home care? We're trying to reduce acute care in the hospital, but in the meantime, a lot of diseases are a gradual process and don't need acute care. The home care issues always come to me when there are terminal illnesses, but there are times when it is a very slow process.

I just want a comment. How much should we look into professional home caregivers? In Vancouver there are some, but it is not adequate. In what way could we improve on that? Nickie, would you like to answer that? You're involved in that.

Ms. Nickie Cassidy: It's a hard one to address, especially with illnesses like MS. Again, I think it depends on where you live and what kind of home care you get. I know the health issues are mostly provincial, which makes it very difficult. There's also the question of whether you live in a rural area or an urban area in how much home care is available right now.

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By and large, it's very little, and there are maximums. I can remember what the maximums are only in Ontario because I live in this province, and they're far below what is required for someone who, say, has progressive degenerative MS as opposed to the relapsing-remitting sort of MS. These people need almost 24-hour care, and you can usually get—I'm just guessing now; I think it's 60 hours per month. So you have to have someone at home as a caregiver, unless you're willing to have a family member or a friend, or whatever, institutionalized. There are no choices. The money isn't there.

In MS cases, there are vastly more women with MS than there are men. You would be surprised at the number of male caregivers, many of whom take early retirement to look after their family members. Women simply have to leave the world of work, which means when it comes pension time, they don't have any, so they're poor for life.

I'm not sure if that's addressing the kind of question you're asking.

Ms. Sophia Leung: Would Kenneth or Allan want to comment?

The Acting Chair (Mrs. Karen Redman): Mr. Kyle.

Mr. Kenneth Kyle: As I mentioned earlier, Health Canada is working with us on a cancer control strategy for Canada, and I would think that would be one of the things that would be looked on. So it's important to support that strategy.

Penny, I don't know if you want to comment, if there is a position from the NVO health groups on home care.

Ms. Penelope Marrett: Maybe Mr. Lefever can comment first.

Mr. Allan Lefever: I'd like to comment on home care from the provincial perspective, because it is a provincial initiative. But I think the fact is very simple. We have an aging population—unfortunately I count myself within that group, and there are those who might say that's a good idea—there will be increased need for home care or providing of care in the home for people who are suffering from debilitating illness, and it's clear that cost of care in the home is less than in an institution. To the degree that you have a family member providing that kind of care, I believe you have better care, and I believe both the patient and the family member are more comfortable with the care, having gone through a personal experience of that kind recently in my own family.

To the degree that the tax regime enables the family member to provide that care without suffering undue negative adverse economic results, it is good for the patient, it is good for the family member, and I would suggest it would be good for all Canadians. I think that's the point we were addressing, the desire to see that benefit enlarged in recognition of the fact that this is going to become an increasing burden. It's already there, as Nickie has already pointed out very clearly, but it's going to increase, and we need to start looking at the fact that the wave is coming and that there will be this need to deal with it.

The Acting Chair (Mrs. Karen Redman): Ms. Marrett.

Ms. Penelope Marrett: As it relates to home care, home care is not under the Canada Health Act. Therefore the five principles of the Canada Health Act are not covered in the provinces. The type of home care that is actually available through the province will depend on which province you live in.

One of the challenges many families have is that their extended family is often not in the same city as they are. Although they may have friends and neighbours, they're still unable to have the type of home care they need available to them through either the health system or through friends and family.

One of the things we have also come to realize is that home care is not just for those people who are getting older, but there are home care needs for younger children as well, particularly for women who are working. This creates an additional burden for them. Oftentimes they are responsible for taking care of elderly relatives as well as younger family members who may also be ill. So I think the recommendations the Heart and Stroke Foundation have made about increasing the caregiver benefit will need to be seriously looked at in the future, because the burden will continue to increase.

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Ms. Sophia Leung: Dr. McLennan, I'm pleased that you quote the report of my alma mater, UBC.

On your second point, to encourage innovation, as you know, the government has given a lot, especially establishing an innovation foundation, and so on. I feel we should look into the private sector also.

You mentioned the pharmaceutical industry. That's a very good example. Can you expand a little more on how we can encourage the private sector?

Dr. Barry McLennan: Yes, Madam Leung. The reality is this. About 20 years ago, the governments, both federal and provincial, said to the university community, there are not going to be increasing amounts of money, substantial increases in money, to the universities, so go and find another source of funding. We turned to the private sector. The pharmaceutical industry is only one.

In the provinces, at least the ones I'm familiar with, there is a substantive amount of funding provided by provincial associations and organizations. Sometimes it's through the volunteer charities. Sometimes there are funds from the insurance companies, from pension funds, and so on. So there are other sources of funding, and I certainly think we need to go after those.

In terms of the global scene with respect to research, there's no question that the research calibre of Canadian science is very high. It's well regarded. You've heard me talk about the brain drain before. One of the negative sides of that, of course, is that our graduates have no trouble getting jobs in other countries. They're well trained and well regarded. Of course, that doesn't help us, because when they move away, they become our competition.

So the point about maintaining the research environment here and having jobs for our graduates in Canada speaks to the issue of getting this foreign investment and getting investment from the private sector, and so on. The pharmaceutical industry is only one of them.

The challenge for us in Canada is that although we are a wonderful country, we're not a big player in the global scene. We're 4%. We're good, but we're small. So the challenge is to convince the head office in Basel, Switzerland, or wherever, that the medical research officer in Canada for that company will have some business, some dollars, to invest in Canada.

The industry is very anxious to invest in Canada. Of course, if I may be a little bit provincial for a minute, we'd like them to invest somewhere other than just Ontario, Quebec, and B.C.—namely Saskatchewan. You'll forgive me for doing that.

But no, the industry is anxious to invest in Canada because of the quality of our work and the quality of our graduates.

So I agree with you. I think we need to go after these other sources. I don't have any problem with doing business with the private sector at all. Not every academic would make that statement, but you need to understand the ground rules. If we're going to do business together, I have to understand your objectives and you have to understand mine. If we can come to an agreement, fine.

Ms. Sophia Leung: I have one little comment. I want to address the Cancer Society and the Heart and Stroke Foundation. In B.C. you're doing an excellent job of reaching out—education, public education for the community, and prevention. I'd like to see that done more. I think that, across the board, would prevent disease and cut down the cost. I just wanted to say that.

Thank you, Madam Chair.

The Acting Chair (Mrs. Karen Redman): Thank you.

I would like to direct a question to Dr. McLennan, if I could, and anybody else who would like to answer can feel free to do so.

You talk about the great anticipation and how well received the 2,000 new research chairs were when the Prime Minister announced that. In my own community, I have two universities, and it's very well received.

Last week in Regina we heard a caution from somebody representing the university out there. They said that because of the cutbacks in the base funding and the squeeze on the finances of universities, the government needed to acknowledge that this would create an exacerbation of a shortage of funds. I wonder if you've looked at that or if you have a comment on that.

Dr. Barry McLennan: Yes, thank you, Madam Chair.

The announcement of the research chairs is fantastic, 1,200 for the first three years and 800 more later on. So it's wonderful news for Canada.

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In some of the smaller universities, particularly those in regions of the country where there hasn't been as much investment in research and there's not as much infrastructure support from the provinces, we're worried about what I'm going to call the cherry-picking phenomenon. If I am a university president or the VP of research, I am going to go and find the very best person I can to head up that research chair, so I will go shopping. That's what I mean by the cherry-picking.

Whether it's from Toronto or McGill or UBC or wherever, I'm going to go for the best person I can. That's going to be a situation wherein the university that can put together the most attractive package for that individual, to attract that high flyer that you want as your research chair...the university that can put the best package together will be competitive. It's a competition. So yes, some of the smaller universities are very worried about this.

That speaks to the rules of the game, which haven't been announced yet, to my knowledge. The only thing I've heard about the program so far is that as a general swath the amount of money going to a university from MRC, NSERC, and SSHRC, the three federal granting councils, will be the first indicator of how many chairs you might expect.

I'm particularly concerned about this in the health research sector, because it's reasonable to assume that 40% of those 2,000 chairs will be in the health research areas, so we need to be competitive there.

For the smaller universities, like the University of Regina, if that's the one you're referring to, I think the terms of reference are going to have to make some allocation. They're going to have to take some consideration of the fact that universities aren't all at the same place on the racetrack with respect to being competitive for these chairs.

The Acting Chair (Mrs. Karen Redman): Would any of the other presenters like to make a comment?

Ms. Marrett.

Ms. Penelope Marrett: I'm hoping that when the government starts to look more at this it will bring together all the stakeholders in health research to talk about how best this can be done. It is an exemplary acknowledgement of the government about the need to increase our ability in research and the need to encourage research, but all the stakeholders sitting around the table together will hopefully be able to come up with the best solution.

Certainly after listening to Dr. McLennan, I think it becomes that much more critical.

The Acting Chair (Mrs. Karen Redman): Ms. Cassidy.

Ms. Nickie Cassidy: I'd like to add to that.

I know that the MS Society funds a number of clinics throughout Canada. This is money that we raise through fundraising. I reiterate what Dr. McLennan says. I'm hearing that there is no brain drain, but we've lost two of our best researchers. George Ebers has just gone over to London; he is the second one to go in the last year.

The clinics we have right now are very fearful about losing the very good people they have, so anything this government can do to help on the research side only helps those of us who are actually suffering—that is a word I hate, but that's the word that's commonly used with these illnesses. It's all we have to hope for, so if this government doesn't give the money for the research that's required, throughout the country, not only in the large centres, those of us who are suffering from the illnesses are ultimately the victims, if you will. There is as well the fact that if that research isn't there, the country as a whole loses because it's losing its best people.

The Acting Chair (Mrs. Karen Redman): Clearly all of the witnesses here represent very important parts of what makes up communities. I know that Ms. Leung talked about specific examples in her community. One of the things that your recommendations clearly point out is the fact that not only are you willing to shoulder how we deliver our services to Canadians, you're more than willing to do that, and you're looking to the federal government to continue a partnership as we reconstruct that delivery model.

One of the things I've heard from some of the home care providers in my community—I come from Ontario—is the fact that when we have provincial governments looking at for-profit deliverers, one of the things they neglect to look at when they zero in on the bottom line or the per unit cost of that delivery is this: they're ignoring the incredible volunteer participation that comes with it, whether it's a VON, the Cancer Society, or the MS Society. For a government, it's always a continuing challenge, I think, to try to measure negative impacts, because how do you measure something that doesn't occur because you invested on the front end?

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I'm just wondering if anyone would care to comment on that conundrum. It's certainly one that I see in my community of Kitchener.

Ms. Marrett.

Ms. Penelope Marrett: Having sat at many tables with organizations like the VON, I certainly learned a lot about some of the issues they're dealing with and, as a result, our communities are dealing with. I don't think we have yet truly understood the impact. As many know, the VON has lost a number of contracts because of the decisions made by provincial governments. One of the things we are beginning to see is that the care given to people is not as good. The people who are delivering the care are not as qualified as the people who have delivered it through the VON and other organizations. As well, the follow-up services that occur through the volunteer component aren't in the process.

One of the things that I know has happened with the VON is that in certain areas they know they're never going to win the contracts, so they've actually had to start to consider closing down some of the work they are doing, which has an impact not just on the home care but on everything else they're involved with. So it is having a great impact.

The Acting Chair (Mrs. Karen Redman): I'd like to thank each and every one of you for coming here and bringing to us your thoughtful recommendations and your presentations. Please rest assured that this will form part of our considerations as we write our report that will go to the Minister of Finance in anticipation of the budget this February.

This meeting is adjourned.